Summary Report for Family Support Plan Service Authorizations (FSPSAs) Overlapping the Report Period Center: 02
This report estimates subtotals of units and fees for the number of days of overlap between each included
FSPSA record and the user-selected report period. For example, if the FSPSA record authorizes services from
01/01/01 to 08/01/01, and the Report Period is selected as 01/01/01 to 03/01/01, this summary calculates
authorized units/fees for the 28 days of overlap (02/01/01 to 03/01/01). Note that service authorization periods
may range from 1 to 12 months and may vary in intensity from child to child.
FSPSAs overlapping: 01-01-23 and 03-31-23 Date of Report: 04-20-23 Page: 1
Eligibility Filter: Program Patients
With the filters selected there were 6438 FSPSA's found
Services Cpt Code Number of Number of Total Units Total Fees Avg Fee
Children Records Overlapping Overlapping Per Unit Auth
Report Period Report Period
Service Coordination, Class # 01
SCONLY-SCONLY *SERVICE COORDINATION ONLY 5 5 10.507937 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 5 5 10.507937 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 62 78 52.043953 $2524.1300 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 4 5 1.476712 $82.8500 $56.1000
AUDE -92555 SPEECH AUD THRESHOLD (DETECTION) 7 8 4.591781 $67.4100 $14.6800
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 1 1 0.246575 $5.4400 $22.0700
AUDE -V5010 ASSESSMENT FOR HEARING AID 1 1 1.000000 $45.3200 $45.3200
AUDE -V5090 DISPENSING FEE PER HEARING AID 4 4 1.247945 $144.5300 $115.8200
EVAL -96111 DEVELOPMENTAL EVALUATION 1 1 12.714286 $635.7200 $50.0000
EXIT -EXIT EXIT ASSESSMENT 28 28 38.428571 $1921.4300 $50.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 3 3 6.000000 $450.0000 $75.0000
IPDEF -T1024GNTSGT F/U PHYC AND DEV EVAL BY SPAT 2 2 4.000000 $300.0000 $75.0000
IPDEF -T1024GOTSGT F/U PHYC AND DEV EVAL BY OT 1 1 2.000000 $150.0000 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 3 3 5.000000 $277.5000 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 112 114 224.505479 $16837.9100 $75.0000
IPDEI -T1024GNUKGT INITIAL PSYCH AND DEV EVAL BY SPAT 45 45 89.500000 $6712.5000 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 57 59 115.285714 $8646.4300 $75.0000
IPDEI -T1024GOUKGT INITIAL PSYCH AND DEV EVAL BY OT 23 23 45.500000 $3412.5000 $75.0000
IPDEI -T1024GPUKGT INITIAL PSYCH AND DEV EVAL BY PT 1 1 2.000000 $150.0000 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 129 141 274.791193 $15250.9100 $55.5000
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 12 13 26.000000 $1443.0000 $55.5000
IPDEI -T1024TL INITIAL PSYCH AND DEV EVAL BY EI PR 36 36 72.000000 $5400.0000 $75.0000
IPDEI -T1024TLGT INITIAL PSYCH AND DEV EVAL BY EI PR 16 18 34.000000 $2550.0000 $75.0000
NUTR -97802 NUTRITIONAL EVAL, INITIAL 1 1 3.000000 $150.0000 $50.0000
OCTF -97168 OT RE-EVAL EST PLAN CARE 3 3 1.200000 $61.6900 $51.4100
OCTH -97165 OT EVAL LOW COMPLEXITY 49 61 35.997280 $1850.6200 $51.4100
OCTH -97165GT OT EVAL LOW COMPLEXITY 2 2 0.520092 $26.7400 $51.4100
OCTH -97166 OT EVAL MODERATE COMPLEXITY 42 45 26.883179 $1382.0800 $51.4100
OCTH -97166GT OT EVAL MODERATE COMPLEXITY 4 5 21.533856 $1107.0600 $51.4100
OCTH -97166TL OT EVAL MODERATE COMPLEXITY 1 1 1.000000 $51.4100 $51.4100
OCTH -97166TLGT OT EVAL MODERATE COMPLEXITY 3 4 10.778865 $554.1400 $51.4100
OCTH -97167 OT EVAL HIGH COMPLEXITY 21 26 10.113469 $519.9400 $51.4100
OCTH -97167GT OT EVAL HIGH COMPLEXITY 1 1 0.338889 $17.4200 $51.4100
OCTH -97167TL OT EVAL HIGH COMPLEXITY 1 1 0.327778 $16.8500 $51.4100
PSTF -97164 PT RE-EVAL EST PLAN CARE 8 10 3.700000 $190.2200 $51.4100
PSTF -97164GT PT RE-EVAL EST PLAN CARE 1 1 0.500000 $25.7100 $51.4100
PSTH -97161 PT EVAL LOW COMPLEXITY 38 46 34.504706 $1773.8900 $51.4100
PSTH -97161GT PT EVAL LOW COMPLEXITY 1 1 0.246575 $12.6800 $51.4200
PSTH -97162 PT EVAL MODERATE COMPLEXITY 25 27 22.033113 $1132.7300 $51.4100
PSTH -97162GT PT EVAL MODERATE COMPLEXITY 8 12 1.846577 $94.9400 $51.4100
PSTH -97163 PT EVAL HIGH COMPLEXITY 15 16 6.544139 $336.4400 $51.4100
PSTH -97163GT PT EVAL HIGH COMPLEXITY 1 1 0.246575 $12.6800 $51.4200
PSTH -97163TL PT EVAL HIGH COMPLEXITY 2 2 0.585464 $30.1000 $51.4100
SPCH -92521 EVAL OF SPEECH FLUENCY 59 69 42.219189 $2170.5000 $51.4100
SPCH -92521GT EVAL OF SPEECH FLUENCY 2 2 0.550000 $28.2800 $51.4100
SPCH -92521TLGT EVAL OF SPEECH FLUENCY 1 1 0.400000 $20.5600 $51.4100
SPCH -92522 EVAL OF SPCH SOUND PROD 7 7 3.449315 $177.3300 $51.4100
SPCH -92522TL EVAL OF SPCH SOUND PROD 3 3 2.164384 $111.2700 $51.4100
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 68 79 47.122905 $2422.6100 $51.4100
SPCH -92523GT EVAL OF SPCH SOUND PROD; EVAL LANG 7 7 4.059295 $208.6800 $51.4100
SPCH -92523TL EVAL OF SPCH SOUND PROD; EVAL LANG 1 1 0.183333 $9.4200 $51.4000
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 10 10 4.127778 $185.1700 $44.8600
SPCH -92610TL EVAL OF ORAL,PHARYNGEAL SWALLOWING 2 3 0.616666 $27.6600 $44.8600
SPL -92526 TREATMENT OF SWALLOWING DYSFUNCTION 4 4 48.857143 $2586.0000 $52.9300
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Subtotal (Total Children Is Unduplicated) 457 1037 1347.982774 $84302.4000 $62.5400
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 74 91 227.526895 $1137632.5000 $4999.9900
AUD -92593TS AUDIOLOGY SERVICES (Biaural) 1 1 0.180822 $9.0400 $49.9900
AUD -92630 AUD REHAB PRELING HEARING LOSS 1 1 1.000000 $69.3500 $69.3500
AUDE -V5160 DISPENSING FEE BINAURAL 5 6 4.910959 $1137.4900 $231.6200
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 52 55 74.908433 $3745.4200 $50.0000
COIFF -COIFFGT IFSP CONSULT,PROF,FACE TO FACE 5 5 7.005556 $350.2800 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 3 3 2.011111 $50.2800 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 415 560 1162.193220 $58109.6700 $50.0000
CONIF -CONIFGT CONSULT,ITDS,FACE TO FACE 2 2 3.300000 $165.0000 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 216 268 542.413247 $27120.6900 $50.0000
CONOF -CONOFGT CONSULT,OT,FACE TO FACE 1 1 3.000000 $150.0000 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 3 4 7.066667 $176.6700 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 43 50 94.495237 $4724.7600 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 390 492 972.893220 $48644.6900 $50.0000
CONSF -CONSFGT CONSULT,SLP,FACE TO FACE 2 2 3.066667 $153.3400 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 4 4 7.400001 $185.0000 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 19 20 172.399999 $8619.9900 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 370 465 3850.166682 $192508.1100 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 53 62 473.357143 $23667.8600 $50.0000
INTR -T1013 INTERPRETER 34 58 167.500001 $8375.0000 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 501 1248 6536.067411 $65360.6100 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 146 182 1635.747622 $117708.3100 $71.9600
OCCT -97530GT OT SESSION BY LICENSED OT 2 2 32.000000 $2302.7200 $71.9600
OCCT -97530HM OT SESSION BY OT ASST 1 1 8.714286 $501.9400 $57.6000
PHY -97110 PT SESSION BY LICENSED PT 109 135 1317.071434 $94776.3600 $71.9600
PHY -97110HM PT SESSION BY PT ASST 1 1 8.571429 $493.3700 $57.5600
SENS -V5060 BEHIND EAR HEARING AID 3 3 1.509589 $346.6200 $229.6100
SENS -V5140 BEHIND EAR BINAURAL HEARING AID 3 4 6.000000 $2755.3200 $459.2200
SENS -V5264 EARMOLD 5 5 4.750685 $86.1300 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 178 211 1782.695242 $128282.6500 $71.9600
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 6 8 58.571429 $4214.8000 $71.9600
SPL -92508HA GROUP SPL SESSION PER CHILD 1 1 12.857143 $179.4900 $13.9600
TRAV -TRAVS Travel by mile 545 1445 350011.082998 $155754.9300 $0.4500
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Subtotal (Total Children Is Unduplicated) 625 5396 369192.435128 $2088358.3600 $5.6600
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Total 6438 370550.925839 $2172660.7500 $5.8600
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Number of Children (Unduplicated) With at Least One Authorization 664